Chapter One THE EISENHOWER PARADOX Flashcards
What did Claude Bernard state about poorly observed facts in medicine?
They form actual obstacles to science, as people insist they must be accepted as facts.
This highlights the challenge of anecdotal evidence in scientific discourse.
At what age did President Dwight D. Eisenhower suffer his first heart attack?
Sixty-four years old.
Where did Eisenhower’s first heart attack take place?
Denver, Colorado.
What was Eisenhower’s condition on the night of his heart attack?
He experienced increasingly severe low substernal nonradiating pain.
Which physician injected Eisenhower with morphine during his heart attack?
Dr. Howard Snyder.
What was the outcome of the press conferences held regarding Eisenhower’s health?
They educated Americans, especially middle-aged men, about cholesterol and dietary fat.
What significant lesson did Eisenhower learn after his heart attack?
To attend to cholesterol and fat in his diet.
What was Eisenhower’s cholesterol level before his heart attack?
165 mg/dl.
What dietary changes did Eisenhower make after his heart attack?
He ate little fat and less cholesterol, using soybean oil and polyunsaturated margarine.
What did Eisenhower switch to when his weight did not decrease?
Melba toast and fruit.
What was Eisenhower’s cholesterol level on January 19, 1961?
259 mg/dl.
Who made the cover of Time magazine advocating for low-fat diets?
Ancel Keys.
True or False: Eisenhower’s diet effectively lowered his cholesterol levels.
False.
What was the role of the American Heart Association regarding dietary fat and heart disease?
They took ten years to support the hypothesis that dietary fat caused heart disease.
What myths supported the national policy of low-fat diets?
- Paul Dudley White’s declaration of a ‘great epidemic’ of heart disease.* The changing American diet story.
What did the heart-disease epidemic narrative suggest about coronary heart disease?
It was uncommon until the 1920s and became the nation’s number one killer.
What medical advancement helped diagnose coronary heart disease more accurately?
The electrocardiogram.
What was the primary cause of heart attacks associated with atherosclerosis?
Blood clots (thrombosis).
What did the International Classification of Diseases add in 1949?
A new category for arteriosclerotic heart disease.
What was the effect of the 1949 revision of the ICD on reported coronary disease death rates?
Raised coronary disease death rates by about 20% for white males and 35% for white females.
What percentage of heart-disease deaths were attributed to ischemic heart disease by 1968?
90%.
What misconception about heart disease was highlighted in the 2001 WHO report?
Much of the apparent increase in coronary heart disease mortality may be due to better certification and diagnosis.
What was the main argument against the idea of a heart-disease epidemic?
The rise in diagnoses was likely due to better recognition rather than an actual increase in disease incidence.
What did the World Health Organization committee state about the increase in coronary heart disease mortality in 2001?
Much of the apparent increase may simply be due to improvements in the quality of certification and more accurate diagnosis.
What significant legislation was passed by the U.S. Congress in June 1948 regarding heart disease?
The National Heart Act, which created the National Heart Institute and the National Heart Council.
How much funding did the National Heart Institute allocate to heart-disease research by 1949?
$9 million.
What was the total amount invested by the American Heart Association in research by January 1961?
Over $35 million.
True or False: The American Heart Association was founded in 1924 as a public health agency.
False.
What was the charitable contribution to the American Heart Association in 1945?
$100,000.
What campaign did the American Heart Association hold in 1948 to raise awareness and funds?
A nationwide fund-raising campaign.
Fill in the blank: The American Heart Association proclaimed the second week in February as _______.
National Heart Week.
What did Ancel Keys claim about the American diet in relation to coronary disease in 1953?
The present high level of fat in the American diet did not always prevail.
What did Senator George McGovern announce in 1977 regarding American diets?
The first Dietary Goals for the United States.
What was the argument regarding the changing American diet and heart disease?
The diet shifted from plant-based foods to animal-derived foods, contributing to heart disease.
What did the USDA food disappearance statistics suggest about American diets at the turn of the century?
Americans were eating 25% more starches and cereals and 25% less fats.
True or False: The USDA food disappearance data are based on reliable evidence.
False.
What historical observation was made about American dietary habits regarding meat?
Americans were traditionally a nation of meat-eaters, suspicious of vegetables.
What effect did Upton Sinclair’s book ‘The Jungle’ have on meat sales?
It caused meat sales in the United States to drop by half.
During the heart-disease epidemic, what significant change occurred in vegetable consumption?
Vegetable consumption increased dramatically.
What was the trend in whole milk and cream consumption from the end of World War II to the late 1960s?
Per-capita consumption of whole milk dropped steadily, and the use of cream was cut by half.
How did the consumption of animal fats change during the heart-disease epidemic?
Decreased from 84 pounds to 71 pounds per capita.
What did Jeremiah Stamler refer to cholesterol as?
The ‘medical villain cholesterol.’
What is cholesterol’s role in the body?
An essential component of cell membranes and a constituent of various physiological processes.
True or False: The initial evidence for the diet-heart hypothesis came primarily from human studies.
False.
What did Nikolaj Anitschkow demonstrate in 1913 about cholesterol and atherosclerosis?
He could induce atherosclerotic-type lesions in rabbits by feeding them olive oil and cholesterol.
What is the condition of having very high cholesterol called?
Hypercholesterolemia
Cholesterol levels above 300 mg/dl are considered hypercholesterolemia.
What did Nikolaj Anitschkow discover in his 1913 study on rabbits?
He could induce atherosclerotic-type lesions in rabbits by feeding them olive oil and cholesterol
This research was criticized because rabbits are herbivores and would not naturally consume high-cholesterol diets.
What factors can influence cholesterol levels in humans?
- Exercise
- Weight gain
- Weight loss
- Seasonal changes
- Body position
- Stress
- Hormonal changes
- Certain medications
Cholesterol levels can fluctuate by 20 to 30 percent over weeks.
What did John Gofman conclude about cholesterol levels in patients with atherosclerosis?
There was no consistent evidence that patients with atherosclerosis had significantly higher cholesterol levels than those without it
Some studies found elevated cholesterol levels, while others disputed this finding.
What was the significance of the autopsy examinations conducted by Warren Sperry and Kurt Landé?
They found no direct correlation between cholesterol levels and the incidence or severity of atherosclerosis
Their findings were significant in questioning the cholesterol hypothesis.
Who is credited with promoting the cholesterol hypothesis linking cholesterol levels to heart disease?
Ancel Keys
Keys argued that dietary fat was a significant factor in heart disease.
What was Ancel Keys’s hypothesis regarding diet and heart disease based on his observations in Naples?
The rich had higher cholesterol levels and more heart disease compared to the poor, who ate less meat
This observation led Keys to conclude that dietary fat was linked to heart disease.
What was the conclusion of Keys’s studies on fat intake and heart disease rates across different countries?
Higher fat intake was associated with higher heart disease rates
Critics noted that Keys’s conclusions were based on selective data from only six countries.
What did Jacob Yerushalmy and Herman Hilleboe argue against Keys’s hypothesis?
They pointed out that including more countries in the analysis weakened the link between fat intake and heart disease
They emphasized that correlation does not imply causation.
What did researchers learn about dietary cholesterol’s effect on blood cholesterol levels?
Dietary cholesterol has an insignificant effect on blood cholesterol for most people
This finding contrasts with the common belief that dietary cholesterol significantly raises blood cholesterol.
What was the common misconception about dietary fat and its effect on cholesterol levels?
That all dietary fat elevates cholesterol levels
Research since the mid-1950s has shown that total dietary fat has little effect on cholesterol levels.
Fill in the blank: The severe condition of atherosclerosis can be evaluated only after _______.
death
True or False: Ancel Keys believed that dietary cholesterol was a significant factor in causing heart disease.
False
Keys eventually concluded that dietary cholesterol had little relevance to heart disease.
What was Ancel Keys’ belief about dietary fat and cholesterol in the mid-1950s?
All fat, both vegetable and animal, elevated cholesterol
Keys believed that to lower cholesterol, one should eat less fat.
What did Laurance Kinsell demonstrate in 1952 regarding vegetable oil?
Vegetable oil decreases the amount of cholesterol circulating in blood
Kinsell was the director of the Institute for Metabolic Research.
What was J. J. Groen’s finding about cholesterol levels in 1952?
Cholesterol levels were independent of the total amount of fat consumed
Groen noted lowest cholesterol levels on a vegetarian diet with high fat.
What crucial factor did Kinsell and Edward Ahrens identify in controlling cholesterol?
The degree of saturation and chain length of the fats
Saturated fats tend to raise cholesterol, while unsaturated fats tend to lower it.
What misconception is taught in high schools regarding animal and vegetable fats?
All animal fats are ‘bad’ saturated fats, and all ‘good’ unsaturated fats are found in vegetables and fish
This oversimplification hinders understanding of diet and heart disease.
What did the 1957 American Heart Association report conclude about dietary fat and heart disease?
There was not enough evidence to make a rigid stand on the relationship between fat content and heart disease
The report criticized researchers for uncompromising stands.
What change occurred in the AHA report released in December 1960?
It suggested Americans could reduce heart disease risk by reducing dietary fat and replacing saturated fats with polyunsaturated fats
This was the AHA’s first official support of Keys’s hypothesis.
What was Ancel Keys’ proposed ideal heart-healthy diet according to Time magazine?
Increase carbohydrates to almost 70% of calories and reduce fat consumption to 15%
This proposal was part of the coverage that enshrined Keys as a dietary authority.
What did the AHA’s 1960 report indicate about those at high risk of heart disease?
Only those at high risk should eat less fat
This included overweight middle-aged men who smoke and have high cholesterol.
What is arteriosclerosis?
The condition in which atheroma accumulates in arteries throughout the body
The term was often used interchangeably with ‘atherosclerosis.’
How much could decreasing cholesterol consumption from 400 mg to 300 mg a day affect cholesterol levels?
It would be expected to reduce cholesterol levels by 1 to 2 mg/dl
This represents a decrease of perhaps 1 percent.
What was notable about the references included in the 1960 AHA report?
It included recent scientific references, many of which contradicted the conclusions of the report
The report was only slightly over two pages long and lacked comprehensive citations.
